Using a theory of change to develop an integrated intervention for depression, diabetes and hypertension in Zimbabwe: lessons from the Friendship Bench project

Abstract Background Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension care into the existing Friendship Bench in order to come up with an integrated care package for depression, hypertension and diabetes aimed at strengthening NCD care in primary health care systems in Zimbabwe. Method A theory of change workshop with 18 stakeholders from diverse backgrounds was carried out in February 2020. Participants included grandmothers working on the Friendship Bench project (n = 4), policymakers from the ministry of health (n = 2), people with lived experience for the three NCDs (n = 4), health care workers (n = 2), and traditional healers (n = 2). Findings from earlier work (situational analysis, desk review, FGDs and clinic-based surveys) on the three NCDs were shared before starting the ToC. A facilitator with previous experience running ToCs led the workshop and facilitated the co-production of the ToC map. Through an iterative process, consensus between the 18 stakeholders was reached, and a causal pathway leading to developing a framework for an intervention was formulated. Results The ToC singled out the need to use expert clients (people with lived experience) to promote a patient-centred care approach that would leverage the existing Friendship Bench approach. In the face of COVID-19, the stakeholders further endorsed the use of existing digital platforms, notably WhatsApp, as an alternative way to reach out to clients and provide support. Leveraging existing community support groups as an entry point for people in need of NCD care was highlighted as a win-win by all stakeholders. A final framework for an NCD care package supported by Friendship Bench was presented to policymakers and accepted to be piloted in five geographical areas. Conclusions The ToC can be used to build consensus on how best to use using an existing intervention for common mental disorders to integrate care for diabetes and hypertension. There is a need to evaluate this new intervention through an adequately powered study.

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The interplay between emotional exhaustion, common mental disorders, functioning and health care use in the working population

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2017.06.018 ◽

2017 ◽

Vol 100 ◽

pp. 8-14 ◽

Cited By ~ 7

Author(s):

Marlous Tuithof ◽

Margreet ten Have ◽

Aartjan Beekman ◽

Saskia van Dorsselaer ◽

Marloes Kleinjan ◽

...

Keyword(s):

Health Care ◽

Mental Disorders ◽

Emotional Exhaustion ◽

Common Mental Disorders ◽

Health Care Use ◽

Working Population

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Common mental disorders in sub-Saharan Africa - What lessons for the developed world

European Psychiatry ◽

10.1016/j.eurpsy.2008.01.191 ◽

2008 ◽

Vol 23 ◽

pp. S52

Author(s):

F.G. Njenga

Keyword(s):

Mental Disorders ◽

Common Mental Disorders ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Developed World

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Optimising implementation strategies of the first scaleup of a primary care psychological intervention for common mental disorders in Sub-Saharan Africa: a mixed methods study protocol for the optimised Friendship Bench (OptFB)

BMJ Open ◽

10.1136/bmjopen-2020-045481 ◽

2021 ◽

Vol 11 (9) ◽

pp. e045481

Author(s):

Ruth Verhey ◽

Charmaine Chitiyo ◽

Sandra Ngonidzashe Mboweni ◽

Ephraim Chiriseri ◽

Dixon Chibanda ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Mental Disorders ◽

Common Mental Disorders ◽

Psychological Intervention ◽

Controlled Trial ◽

Implementation Strategies ◽

Evaluation Framework ◽

Sub Saharan Africa ◽

Clinical Trial Registry ◽

Randomised Controlled

IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016.Methods and analysisThis study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies through comparing high-performing and low-performing clinics; and (3) use the results from aims 1 and 2 to develop strategies to optimise the Friendship Bench intervention and apply this model in a cluster randomised controlled trial to evaluate potential improvements among low-performing clinics. The trial will be registered with the Pan African Clinical Trial Registry (www.pactr.org). The planned randomised controlled trial for the third research aim will be registered after completing aims one and two because the intervention is dependent on knowledge generated during these phases.Ethics and disseminationThe research protocol received full authorisation from the Medical Research Council of Zimbabwe (MRCZ A/242). It is anticipated that changes in data collection tools and consent forms will take place at all three phases of the study and approval from MRCZ will be sought. All interview partners will be asked for informed consent. The research team will prioritise open-access publications to disseminate research results.

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Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.665611 ◽

2021 ◽

Vol 12 ◽

Author(s):

Edith Kamaru Kwobah ◽

Ann Mwangi ◽

Kirtika Patel ◽

Thomas Mwogi ◽

Robert Kiptoo ◽

...

Keyword(s):

Health Care ◽

Mental Disorders ◽

Health Care Workers ◽

Early Phase ◽

Healthcare Workers ◽

Online Survey ◽

Stress Disorder ◽

Common Mental Disorders ◽

Generalized Anxiety ◽

Care Workers

Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic.Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant.Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers <35 years old compared to older ones (38.1 vs. 26.4%, p < 0.001), and those who were not married compared to those who were married (40.6 vs. 27.6%, p < 0.001). Generalized anxiety was commoner among workers aged <35 years (43.5 vs. 29.3%, p < 0.001), females (41.7 vs. 29.2%, p < 0.001), those who mere not married compared to the married (45.2 vs. 31.2%, p < 0.001) and those with <10 years working experience (41.6 to 20.5%, p < 0.001). Younger health care professional had a higher proportion of insomnia compared to the older ones (30.3 vs. 18.6%, p < 0.001). Insomnia was higher among those with <10 years' experience compared to those with more than 20 years' experience(27.3 vs. 17.6%, p = 0.043)Conclusion: Many Kenyan healthcare workers in the early phase of COVID-19 pandemic suffered from various common mental disorders with young, female professionals who are not married bearing the bigger burden. This data is useful in informing interventions to promote mental and psychosocial wellbeing among Kenyan healthcare workers responding to the pandemic.

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Common mental disorders, suicidality and use of health care services during late adolescence in Finland

Journal of Adolescent Health ◽

10.1016/s1054-139x(99)00108-1 ◽

2000 ◽

Vol 26 (1) ◽

pp. 2-3 ◽

Cited By ~ 2

Author(s):

Jukka Hintikka ◽

Ulla Hintikka ◽

Johannes Lehtonen ◽

Heimo Viinamäki ◽

Kaj Koskela ◽

...

Keyword(s):

Health Care ◽

Mental Disorders ◽

Health Care Services ◽

Common Mental Disorders ◽

Late Adolescence ◽

Care Services ◽

Use Of Health Care

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Common Mental Disorders

Psychology: Volume 4 ◽

10.1093/oso/9780199498871.003.0002 ◽

2019 ◽

pp. 31-56 ◽

Cited By ~ 1

Author(s):

R. Raguram

Keyword(s):

Health Care ◽

Mental Disorders ◽

Somatoform Disorders ◽

Common Mental Disorders ◽

Adjustment Disorder ◽

Emotional Symptoms ◽

Co Morbidity ◽

Wide Range ◽

Icd 10 ◽

High Degree

This chapter focuses on common mental disorders (CMDs). These disorders include a wide range of conditions that are frequently noticed in the community. It is essentially a convenient, functional grouping of conditions. The chapter analyses the trends on the basis of researches in this area over the past decade. The classification of CMDs for primary health care, according to ICD-10, includes depression, phobic disorder, panic disorder, generalized anxiety, mixed anxiety and depression, adjustment disorder, dissociative disorder, and somatoform disorders. Irrespective of the nature of the disorder, these patients often present with somatic complaints: some patients may admit to having emotional symptoms. It was observed that there is a high degree of co-morbidity among them, leading to significant levels of disability and increased health-care costs.

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The Use of Antidepressants, Anxiolytics, Sedatives and Hypnotics in Europe: Focusing on Mental Health Care in Portugal and Prescribing in Older Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228612 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8612

Author(s):

Marta Estrela ◽

Maria Teresa Herdeiro ◽

Pedro Lopes Ferreira ◽

Fátima Roque

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Older Patients ◽

Common Mental Disorders ◽

Health Policies ◽

Depression And Anxiety ◽

Treatment Gap ◽

Mental Health Policies

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.

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O3.6. PREVALENCE OF AND RECOVERY FROM COMMON MENTAL DISORDERS INCLUDING PSYCHOTIC EXPERIENCES

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa028.017 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S8-S8

Author(s):

Jesus Perez ◽

Clare Knight ◽

Debra A Russo ◽

Jan Stochl ◽

Peter B Jones

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorders ◽

Common Mental Disorders ◽

Psychotic Experiences ◽

Recovery Rates ◽

Psychological Therapies ◽

Primary Mental Health Care ◽

Threshold Score

Abstract Background Systematic reviews indicate that approximately one third of people with at-risk mental states for psychosis (ARMS) will transition to a psychotic disorder. Research in non-specialised services, such as primary care settings, has shown that far fewer make such a conversion. Nonetheless, psychotic experiences (PE) may also be linked to common mental disorders (CMD), particularly depression and anxiety, and still predict poor outcomes. Population studies modelling the co-occurrence of CMD and PE have found an underlying unitary psychopathological factor, with PE emerging towards its more severe end. We know little about the prevalence of and recovery from PE in primary mental health care, where most CMD are treated. One example of primary mental health care setting in England is the Improving Access to Psychological Therapies (IAPT) programme (https://www.england.nhs.uk/mental-health/adults/iapt/). The IAPT programme provides evidence-based psychological therapies for mild to moderate CMD across the UK National Health Service (NHS). IAPT services adhere to current diagnostic paradigms and, therefore, do not either measure or treat PE. We aimed to establish the prevalence of PE in a large sample of patients with CMD from the IAPT programme and compare recovery rates between patients with CMD and PE (CMD-P) and those without PE. Methods We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients with CMD receiving treatment from IAPT services across England. We employed the CAPE-P15 threshold score of 1.47, which identifies individuals with ARMS, and also a lower threshold of 1.30, chosen as within one standard error of measurement, in order to explore threshold effects in the association between PE and recovery. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected in IAPT services and determine ‘caseness’ before, during and after therapy. Using recovery rates (moving from ‘caseness’ to recovery) monitored nationally in the IAPT programme, we stratified patients according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group. Results 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of CMD-P was 29.68% at CAPE-P15 threshold score for ARMS, i.e. 1.47, and 48.09% at threshold score 1.30. The overall recovery rate at threshold of 1.47 was 27.87% and 36.3% at 1.30. Recovery rates for those without PE were 58.92% and 62.43% for thresholds 1.47 and 1.30, respectively. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with CMD-P impeded their likelihood of recovery during treatment. Discussion At least one in four patients receiving treatment from IAPT services in primary care experience CMD-P. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services. Although recovery trajectories for this group showed improvement over therapy sessions, remittance of symptoms was insufficient to meet national IAPT standards of recovery. This patient group is not well-served by current interventions in primary care. This work forms part of a nation-wide NIHR research programme (TYPPEX; https://www.nihr.ac.uk/news/innovative-mental-health-study-launchesin-eastern-region) aiming to develop innovative therapies for people with CMD-P in primary care. Preliminary results related to feasibility and effectiveness of new therapeutic approaches will also be presented.

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